Purim 2020

Register for Purim Festivities

Purim 2020

First Name*

Last Name*

Email*

Phone*

Street*

Street 2 (Apt or Suite)

City*

State*

---select state---

Zip Code*

Tuesday Dinner Adults

Tuesday Dinner Kids

Tuesday Dinner Total Amount $

Sponsorship Level

---Select Sponsorship Level---

Please list names (and ages of children) of any attending family members

Questions / Comments / Seat Requests (optional)

Are you a paid-up member of the Aish Center for 2019-20? If so, check the box for a 15-percent discount.

Member discount

Would you like to cover the 3% processing fee for credit card payments?

Add processing fee

Card Type*

---select card---

Card Number*

Expiration Month*

---select month---

Expiration Year*

---select year---

CVV Code*

Total Amount $

1 time payment